Healthcare Provider Details

I. General information

NPI: 1992888226
Provider Name (Legal Business Name): JUAN TAN ARISTORENAS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 WEST MAIN STREET
ADAMSVILLE TN
38310-0311
US

IV. Provider business mailing address

135 W MAIN ST.
ADAMSVILLE TN
38310-0311
US

V. Phone/Fax

Practice location:
  • Phone: 731-632-3373
  • Fax: 731-632-9335
Mailing address:
  • Phone: 731-632-3373
  • Fax: 731-632-9335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00008527
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: